Diagnostic implications of bronchial lavage in patients with pleural tuberculosis

Introduction: The presence of Mycobacterium tuberculosis in a respiratory specimen is diagnostic in patients with pleural effusion. It is difficult to obtain sputum even after induction in these patients. An alternative method of acquiring respiratory specimens is via bronchial lavage. This study was undertaken to evaluate the diagnostic yield of acid-fast bacilli (AFB) smear, AFB culture, and Xpert assay of bronchial lavage fluid in the workup of pleural tuberculosis patients.Material and methods: All patients who met the inclusion criteria of the study underwent thoracentesis, pleural biopsy, and bronchial lavage. Specimens of pleural fluid, pleural biopsy, and bronchial lavage fluid were sent for acid fast bacilli smear, culture, and Xpert assay.Result: Bronchial lavage AFB smear, culture, and Xpert assay was positive in 9.5%, 17.9%, and 26.2% of patients, respectively. It gave an immediate diagnosis in 22 (26.2%) patients.Conclusion: Bronchial lavage, though not a surrogate to pleural biopsy, offers an additional approach to the early diagnosis of pleural tuberculosis in patients not producing sputum. Besides being diagnostic, this method also has epidemiologic significance in containing the tuberculosis epidemic because detecting Mycobacterium in bronchial lavage confirms that the patient is infectious

Role of medical Thoracoscopy in the Management of Multiloculated Empyema

Abstract Background The treatment of early pleural empyema depends on the treatment of ongoing infection by antimicrobial therapy along with thoracocentesis. In complicated empyema this treatment does not work and lung will not expand until removal of adhesions. The objective of the current study is to analyze the experience of management of multiloculated, exudative and fibrinopurulent empyema through rigid medical thoracoscopy under local anaesthesia and to explore new ways to manage the entity. Methods This is a descriptive case series in which 160 patients were recruited through non-probability convenient sampling, from department of pulmonology, Jinnah postgraduate medical centre, Karachi, from September 2014 to August 2016. All patients underwent medical thoracoscopy under local anesthesia. Written Informed consent was taken from the study participants. Ethical approval was obtained from Ethical Review Committee of the hospital. Patients age > 70 years, those with multiple organ failure and bleeding disorders were excluded. Results Out of 160 patients, 108 (67.50%) were male and 52 (32.5%) were female with mean age 25.37 years (range 16 to 70 years). Out of total, 102 (63.7%) had tuberculous empyema, while pleural biopsy of 58 (36.3%) patients was suggestive of non-tuberculous empyema. Final evolution through chest x-ray revealed complete resolution in 92 (57.5%), partial resolution in 58 (36.25%) patients. 9 (5.6%) developed persistent air leak while 1 (0.6%) patient expired due to urosepsis. Conclusion Medical Thoracoscopy under local anesthesia is a safe, efficient and cost effective intervention for management of complicated empyema, particularly in resource constraint settings

Abnormal Renal Function Tests at Presentation in Severe COVID-19 Pneumonia and its Effect on Clinical Outcomes

Objective: To determine the incidence of abnormal renal function tests at presentation in patients from Karachi admitted with severe COVID-19 pneumonia and determine its effect on disease severity and clinical outcomes. Study type,settings& duration:This was a cross-sectional study conducted at the COVID Intensive care unit of a largetertiary care government hospital in Karachifrom February2021to June2021. Methodology:A totalof 190 patients admittedover five months were included in the study. Patient demographic characteristics, comorbidities, and clinical manifestations of COVID-19 infection were recorded. Laboratory values at the time of presentation, including hemoglobin,neutrophil lymphocyte ratio, platelets, blood urea nitrogen,estimated glomerular filtration rate (eGFR), inflammatory markers, liver function tests, and electrolytes were recorded. Patient outcomesand need for mechanical ventilation were assessed 28 days after admission and compared with the incidence of abnormal renal functions at presentation. Results:Mean eGFR and BUN at presentation were 69.7 and 28.4 respectively. Of the total,109 (57.4%)patients had abnormal renal function tests at the time of presentation. Among them,76 (40%)patients had low eGFR and 33 (17.4%)had only raised BUN with normal eGFR. Mean eGFR was lower in non-survivors vs survivors (p-value 0.000) and in patients who required mechanical ventilation (p-value 0.008). Patients whohad low eGFR showed greater mortality than those with normal eGFR (p-value 0.04) and were more likely to require mechanical ventilation (p-value 0.04). Conclusion:Low eGFR at presentation is common in patients with severe COVID-19 pneumonia and is associated with a higher in-hospital mortality rate and need for mechanical ventilation

Diagnostic Implications of Bronchial Lavage in Patients with Pleural Tuberculosis

Introduction: The presence of Mycobacterium tuberculosis in a respiratory specimen is diagnostic in patients with pleural effusion. It is difficult to obtain sputum even after induction in these patients. An alternative method of acquiring respiratory specimens is via bronchial lavage. This study was undertaken to evaluate the diagnostic yield of acid-fast bacilli (AFB) smear, AFB culture, and Xpert assay of bronchial lavage fluid in the workup of pleural tuberculosis patients. Material and methods: All patients who met the inclusion criteria of the study underwent thoracentesis, pleural biopsy, and bronchial lavage. Specimens of pleural fluid, pleural biopsy, and bronchial lavage fluid were sent for acid fast bacilli smear, culture, and Xpert assay. Result: Bronchial lavage AFB smear, culture, and Xpert assay was positive in 9.5%, 17.9%, and 26.2% of patients, respectively. It gave an immediate diagnosis in 22 (26.2%) patients. Conclusion: Bronchial lavage, though not a surrogate to pleural biopsy, offers an additional approach to the early diagnosis of pleural tuberculosis in patients not producing sputum. Besides being diagnostic, this method also has epidemiologic significance in containing the tuberculosis epidemic because detecting Mycobacterium in bronchial lavage confirms that the patient is infectious